Gluteal, abdominal, and thoracic multiple impalement injuries

Abstract

Rationale: Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients. Patient concerns: A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way. Diagnosis: Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object. Interventions: After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery. Outcomes: Patient was discharged on 9th postoperative day in good general clinical condition. Lessons: Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.

Perineal impalement extending through multiple cavities by iron rod following fall from elevated plane: Case report

“…Perineal impalement represents an extremely uncommon type of trauma, being, in the vast majority of cases, associated with severe injuries that can compromise vital structures in the pelvis, abdomen, and even the thorax [ 4 ]. The high morbidity and mortality, highlighted by approximately 25 % of patients who do not survive until hospital admission, underscore the severity of this type of injury, particularly in extensive impalements [ 5 ].…”

Management of thoracoabdominal impalement in a 12 weeks-pregnant woman: a case report from the Democratic Republic of the Congo

“…Thoracoabdominal impalement describes a traumatic lesion due to the abnormal presence of penetrating, long and solid objects involving the thoracic, and the abdominal cavity with diaphragmatic involvement (1). Author describes classically impalements caused by falls, blasts, impalement after an accident in construction areas, in a traffic accident, and impalement following sexual malpractice (2)(3)(4)(5). Depending on its localization, the lesion may involve vital organs such as the heart, lung, liver, kidney, or thoracic vessels; however, most of the time; vital structures are displaced rather than transfixed.…”

“…This is an open article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licences/bync/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited recommended by authors (4,7). Depending on the lesion complexity, perioperative care may involve complex management strategies including patient positioning, blood management strategies, and challenging anesthetic management for the surgical procedures.…”

“…Thoracoabdominal impalement is extremely uncomfortable for the patient, imposing delicate perioperative management for the surgical and anesthetic team. The involvement of solid and vital organs, the risk of short-term hemorrhage, and the risk of infection are important factors influencing the prognosis of these patients (3)(4)(5). The pregnancy condition adds concerns to this life-threatening event regarding fetal outcomes (6).…”

Rare penetrating abdominal injury caused by falling from height: Miraculously good prognosis

“…The first-hand medical handling of the patients who Abdominal CT scan + enhancement + post-processing (image reconstruction) showed that metal penetrating injury of left perineum, pelvis, left sacrum and ilium, the left internal iliac artery distal segment was not clearly displayed due to the artifact, and the relationship with the foreign matter was difficult to assess. suffered from penetrating injuries and the operation process during transportation may be accompanied by some wrong operations or rescue measures, which may aggravate the physical condition and lead to fatal and irreversible damage to these patients (10,11). Nevertheless, the penetrating abdominal injury is part of the trunk injury, it may caused progressive dyspnea, and are in critical condition and hemodynamically unstable.…”